Clinical Resolution of Red Cell Aplasia Associated del 17p Multiple Myeloma, When Treated With Bortezomib and Dexamethasone

Red cell aplasia has been rarely described in association with multiple myeloma. We present a case of a 79-year-old female, who was initially diagnosed with iron deficiency anemia, which did not improve with iron supplementation and required blood transfusions. Bone marrow biopsy showed red cell aplasia associated with kappa light chain multiple myeloma with 14.8% plasma cells. Further tests showed 0.35 g/dL M protein, and kappa/lambda ratio was 131.84. Cytogenetic showed deletion 13q, deletion 17p, loss of 1p and gain of chromosome 5. Multiple myeloma directed treatment with bortezomib and dexamethasone was initiated. Patient had clinical resolution of anemia and did not require further blood transfusions. This is an intriguing case of red cell aplasia associated with poor risk multiple myeloma (del 17p), which showed clinical improvement in anemia with bortezomib-based therapy. This case highlights the role of clonal plasma cells proliferation in the pathogenesis of red cell aplasia as myeloma directed treatment helped patient to become transfusion independent.